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General NPI Number Information
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NPI Number | 1033410972
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Entity Type | Organization
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Legal Business Name | DUSTIN S. RAGAN PC
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Dates
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Enumeration Date | 11/09/2010
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Last Update Date | 04/28/2022
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Provider Practice Location Address
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Address Line | 201 S 3RD STREET
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City | MCALESTER
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State | OK
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Zip | 74501-5448
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Country | US
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Telephone | 918-426-9900
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Fax |
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Provider Business Mailing Address
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Address Line | 201 S 3RD ST
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City | MCALESTER
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State | OK
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Zip | 74501-5443
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Country | US
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Telephone | 918-426-9900
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DUSTIN SHANE RAGAN
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Credential | DDS
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Telephone | 918-423-9900
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 5879
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License Number State | OK
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